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Thyroid UK
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Chronic joint pain in feet

First-time poster here. I've been having on-and-off excruciating pain in my metatarsals for over three years. I was diagnosed with Hashimoto's Thyroiditis in Oct 2014 with antibodies off the charts. I also did the adrenal fatigue saliva test and my results were almost flatline, at the bottom.

My naturopath (US) put me on 5 mcg of T3 from a compounding pharmacy. I've never been tested for reverse T3. I have been retested for thyroid function and various other things since, and my antibodies have come down. Vit D, ferritin, b12 are all much improved, thanks to the supplements protocol the naturopath recommended. My latest TSH was .71, which is half of what it was justjust 6 months prior. All of these are signs of progress.

But my feet are in excruciating pain that is worst in the morning and gets better as the day goes on. In fact, I am a runner, and have found that my feet feel better when I exercise.

I had xrays done at a podiatrist's office and there doesn't seem to be anything unusual going on with my joints. So what could this be? It is mystifying and debilitating.

31 Replies

I forgot to mention that I am gluten free.


Welcome to the forum, Coreyf.

What are the vitD, B12 and ferritin results (with ranges please)? Low levels commonly cause musuloskeletal pain.

There's no need to test rT3 when on T3 only. It's unconverted T4 pooling which can cause high rT3. Do you have a FT3 result? Low FT3 can cause pain.

Gluten-free diet can help manage Hashimoto's and reduce antibodies.


Test results from early July 2015


FT3=2.6, RR 2.3-4.2 pg/mL

FT4=1.1, RR 0.8-1.8 ng/dL

Ferritin=49, RR 10-232 ng/mL

B12=385, RR 200-1100 pg/mL

Vit D,25-OH, Total, IA=43, RR 30-100 ng/dL

DHEA-S=83, RR 19-231 mcg/dL

Test results from January 2015


FT3=2.6 (same RR as above)

FT4=1.2 (same RR as above)

Test results from October 2014




RT3=16, RR 8-25 ng/dL


B12=? doesn't appear to have been tested at this time

Vit D, 25-OH, Total, IA=24



Coreyf, FT3 is low in range, in or near the top third of range is optimal ie >3.5. Ask your naturopath whether T3 can be increased to 10 or 15mcg.

Ferritin 49 is low, halfway through range is optimal. Supplement iron and take each tablet with 500mg-1,000mg vitamin C to aid absorption and minimise constipation. Take iron 4 hours away from T3.

B12 is also low, 1,000 is optimal. Neuropathy can be experienced <500. Supplement 1,000mcg methylcobalamin sublingual lozenges, spray or patches and take a B Complex vitamin to keep the other B vits balanced.


VitD 43 is suboptimal, optimal is 50-60 ng/ml. See the link below for dosing guideand take 4 hours away from T3.


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Clutter, thanks for the information. Since testing abysmally low last October in ferritin, B12, and vitD, I've been supplementing. I know it's not going to happen overnight, and the reason I showed my labs from three different occasions is to show the changes--in this case, the improvements. My naturopath said with my level of adrenal fatigue it could take up to two years to get back to normal.

I take vitD/K2 combination at night--because I read that you synthesize this at night. I also take methyl factors, magnesium, zinc, vit c. I drink a brew of nettle leaf tea for ferritin. It's all working--it's just happening slowly, as has been expected.

I'm not sure that my T3 needs to be increased. I do suspect that taking it first thing in the morning could cause naturally higher cortisol levels to interfere with it. I just started taking it late morning, to see if that has any effect. I'm not talking hard science here, but because each person is unique, a bit of trial and error is called for.

I have also suspected that I may have calcific tendinitis. I have a few bulging finger joints, that blow up seemingly overnight at times. I also have on and off pain in my shoulder. Since my joint xrays of my hands and feet look basically normal, it must be something to do with my tendons. I've seen a rheumatologist who said I didn't have textbook rheumatoid arthritis (it does not mirror on each side of the body) but prescribed Hydroxychloroquine. I took one dose of the stuff and six hours later had tinnitus that has not gone away, and it's been 15 months. I stopped taking that stuff and did not go back to the rheumatologist.

I also saw a podiatrist, who was not particularly helpful, since nothing seems to be wrong with my bones. I'm a little concerned about seeing an orthopedist because, well, they like surgery.


Corey, FT3 is low and raising it may make the difference. Carpal tunnel and Tarsal tunnel syndromes are common in undermedicated hypothyroidism. Certainly worth seeing whether increased T3 might improve symptoms.


I too suffer with terrible foot pain. I was treated for plantar fasciitis with cortisone injection and that did help for a while. A couple of years later I was in extreme pain with both feet. Couldn't put my feet on the floor in the morning and had to wander around for a while to get them to ease off. If I walked the dog for 15 mins them sat down, I would have the pain again when I tried to get up from the chair. I have since been diagnosed with osteoarthritis in feet and a condition called erythromelalgia that causes my feet to burn at night. I also developed a burning tongue. I blame the thyroid problems for all of these bizarre symptoms. Dee


hi doris59

I don't have the answer but noticed you said you had a burning tongue. I read somewhere a long time ago that if the tip of your tongue feels like it's burning then it's a lack of iron. Just thought I'd mention it as if you can get one problem solved it's a help?

I also have had this pain in my feet but it only lasted a couple of days, which makes me think it's more to do with something I was lacking rather than an actual bone problem ...and I agree, it's probably related to the thyroid problems we have? Hope it goes better for you?

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Hi Dee. Burning feet and tongue are neurological symptoms of B12 deficiency and should be treated without delay.

B12 deficiency is often misdiagnosed as something else as very few GPs understand the symptoms, have read latest research and guidelines or know that it is often linked both ways with autoimmune thyroid disease.

Here are links to more info on symptoms and treatment:

ukneqas-haematinics.org.uk/... :



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Thanks for that Polaris. I will look into the B12 supplements. Should I take this on its own or as part of a general vitamin supplement. Dee


It would be wise to have your B12 tested first as any supplements will skew results. Best to read up and list your symptoms as very few GPs have a clue and you have to be prepared to fight your corner.

Injections are essential for neurological symptoms as, if not treated aggressively, they can become permanent,

If you are deficient, there is not enough B12 in a multivitamin to make a difference.


If your only on 5mcg of T3 that's not enough to treat a fly

muscle and joint pains are typical with Hashimotos and can also be caused by levothyroxine and T3

For some people the only way to get rid of the pain is to switch to NDT

It does take at least a year of optimal treatment on NDT before you should think of exercise because it takes that long for the body to repair


Could it Morton's neuromas? I have them in both feet, they feel like pebbles, or nerve pain around the metatarsals, or just excruciating sometimes. It took over 15 years for anyone to diagnose mine though! They can't be seen on ex-ray only on ultrasound or MRI sometimes, but can be felt: en.wikipedia.org/wiki/Morto... Even if your second toe is just longer than the first it can cause problems and pain in the metatarsals: triggerpoint.ca/index.php?p...


Not sure. I've explored this possibility, but I would think that these would hurt continuously, whereas my pain has waxed and waned over the past 3.5 years.


No mine used to hurt if I stepped on them suddenly, then they'd hurt for a while after a sort of violent nerve pain making it almost impossible to walk. But since I've found half orthotics that raise my instep they haven't hurt much at all. Just thought it may be worth checking out, you'd be able to replicate the sensation by prodding your feet all around where it hurts if you do have them!



I suffer with foot pain but I was treated for a vit d deficiency and the pain went away. I only now get the pain if I've not taken my vit d in a week or so. Days then of foot pain and achy bones when moving about. Take my vit d and pain goes away.

I hope it helps


I would say try upping your dose of T3 - eg doubling it. When I am under medicated I get the same thing - pain in the soles of my feet when I get up in the morning. It went away completely when I increased my dose (I am on Levothyroxine). It's worth a try and you should be able to tell the difference within a few days if it is going to work. Most people feel good with their FT3 level much higher in the range than yours is - yours is near the bottom of the range. Your dose of T3 is very low - frequently people are on 20-30mcg a day.


Also - and it might not help with the feet but with other things - your ferritin is still too low. Get it up to at least 90, maybe a bit higher since you have been low in iron for a while.

I don't know why hypo causes foot problems, but it seems widespread - numbness, pain, stiffness. I can't wear even a quarter inch heel without pain and I am becoming an expert on gel inserts. Which was never an ambition of mine.

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Thanks, Aspmama. I'm doing my best to increase ferritin. I'm pretty sure that I've had low iron issues nearly my entire life--I once tried to give blood in my 20s and they refused me because I failed the centrifuge test.


Sorry you're suffering with this.

I have had excruciating pain in my feet since 2007, sorry to say whatever I've done, B12 injections, high doses of T3, vit D supplementation, iron, NDT hasn't touched it. Orthotics made by the hospital did nothing either although i wore them for two years.When it first started I couldn't move my toes at all, I know it isn't plantar faciitis, because I had a scan. My calves are very tight, I don't think helps at all. My right foot has been left with my toe spacing much wider apart than before. Where my toes join my feet are always swollen at the bottom. It's a burning, nerve pain but walking with hot pebbles in my shoes feeling. It often keeps me awake at night, gabapentin helps with the pain.

Painful walking has been by far the main culprit for weight gain.

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This bums me out. Do you have any issues with your hands? The reason I ask is because I do, on some fingers, as well as my left shoulder. I think it could be calcific tendinitis but don't know for sure. I have been taking raw apple cider vinegar twice daily, hoping to break up the calcium deposits, plus I take magnesium and just started using magnesium oil on the skin of my affected areas.


Hi coreyf, sorry didn't want to upset you.

I have arthritis, since my late 20's and yes I know I have calcium deposits in my right shoulder. I had a frozen shoulder at 33, then a few years back it got really painful with an impinged shoulder, and x rays showed the calcium deposits.

With my hands I've had trigger finger and osteophytes on the end joints of my fingers. I had to have some bone shaved off from my thumb joint. These bony lumps started in my 40's which I believe is very young to get this

I found out my inflammation has been very high for many years. Since joining this site I have had two adrenal stress profile tests which have shown very low cortisol and adrenal exhaustion. I think all this has contributed to getting arthritis so young.

Magnesium has made no difference other than making me open my bowels a bit easier!

I started taking hydrocortisone quite a few months back hoping it would cure all my pain, but it hasn't.

Hashimotos diagnosis was missed for over 20 years according to a private doctor I saw. My tongue has been very enlarged, and I had so much mucin under my skin you just couldn't pinch anything up anywhere on my body. My temperatures were in the 35 degrees too. I think all this has contributed

Never got rid of my swollen ankles and most of the time my hands are swollen and stiff making it difficult to write.

I would love to take cider vinegar, but I have interstial cystitis, so nothing acidic can be consumed.

I wish I could help because I know how depressing this is. With my feet resting overnight makes no difference to the pain, or the swelling.


I should never complain about pain again. I have a friend with IC and she has suffered tremendously. To think you have that, plus arthritis, plus Hashimoto's--I feel for you.


Also, weirdly, as a lifelong runner who does not run huge miles anymore (because of adrenal fatigue), I have found that hiking or running actually makes my feet feel better. They hurt worst in the morning and gradually get less painful as the day goes on. If I go running, which hurts like hell sometimes, they seem to feel better the next day. This has been the only thing (and cycling) that has prevented me from gaining weight.


Honestly, I have no idea how you run at all! Adrenal fatigue has totally wiped me out. Even walking a few metres I'm tired and breathless. Not so long ago I would walk from the store's car park into the store and need to find somewhere to sit lol! I think anaemia was contributing too to all that. When I take iron it really helps but I haven't been able to take it for a couple of months because my anal fissures have been bleeding. Really have felt I've been slipping back, so I will take some iron and see how I go now they've improved.

What are you doing for your adrenals?

My foot pain can be worse at night when I'm resting. If I've been out, the pain gets worse and can keep me awake until I take gabapentin. I am really weird because the more exercise I do , the more my body hurts.

Honestly I'm amazed by how much you can do, brilliant :-)

Re IC in the early years before I had a proper diagnosis I thought about ending my life, because I was in intense pain every hour of every day, and I would need to pee every 10 minutes day and night. It took me five years to get diagnosed and get some treatment. The drug that has helped me the most has been hydroxyzine, I take 75 mg in the evening. I also follow a strict non acid diet. I still get flares in symptoms but not as often as I did. I had my bladder stretched under anaesthetic, and for me it has worked really well, as I'm able to hold more urine.


I don't know why I'm the opposite, but I find that if I don't exercise, I feel worse. Especially my feet. I cycle to and from work every day (only about 4 miles one way), and run 2-3 times per week. When this foot pain began to rear its ugly head in April 2012 I stayed away from exercise and running for six months. My feet never improved, and I hadn't yet been diagnosed with Hashimoto's. I made the decision to start running, and my feet started feeling better.

But they always cycle back to feeling terrible. This past round has lasted about 4 months, with some weeks worse than others. I do get flare-ups in some of my fingers and my shoulder, but that seems to be manageable right now.

As for iron, I drink nettle leaf tea--a tablespoon or two steeped overnight and then drunk the next day. My ferritin levels are rising, though not incredibly quickly. Taking magnesium helps with constipation, as well as binding with free calcium. I just started using magnesium oil on my feet in the morning and at night, and it may be helping. My only gauge is that my feet don't hurt as much over the past couple of days.

For my adrenals, I also try not to drink coffee or alcohol. I've taken pharmaceutical grade DHEA-5 but am a little reluctant to do this, as it's just not the "natural" way. I try to eat regularly, like every 2-3 hours so my body isn't stressed. I'm working on drinking more water, as that's always been a problem. I've reduced stress as much as I can right now. I cannot give up exercise, but I no longer train for long-distance running. Too much physical stress.

And, strangely enough, really being able to be yourself without worrying what other people think helps reduce stress. At my age (48), I've figured out how to do this. Letting things go that are out of your control--priceless.



Corey, I think maybe because I have wide spread arthritis, I know if I step out of my normal range of movements I am absolutely crippled. I can't think of a better word, I hate to say cripple. Whenever I have had physio things just got worse. I had surgery on my knee which hasn't helped much. I was told I need knee replacements at 49 it's that bad. I was diagnosed with fibromyalgia, doctors just couldn't believe it was arthritis because I was in my 20's when it started. Then eventually when I had scans and xrays just about everything in my body is damaged.

I know you are very active, but do you get problems with rock hard inflexible calf muscles? This came a couple of years before my foot pain. I'm always being told that my body is very tight by doctors. Hashimotos has definitely affected my muscles and because I went untreated for so long my nerves. I saw one really great physio who told me about my nerves being very bad. After an examination I wouldn't be able to move and a lot of the time I've had to sleep on the sofa as I can't get up the stairs. I just tell doctors now, don't do anything with my body or I'll pay for it. I even thought I had MS it's been so bad. Since thyroid meds sometimes my calf muscles are a bit softer.

I take prescribed iron because I need it in a large dose. When you have IC you are losing blood in your urine all the time. Whenever I've had to use dipsticks, it's always plus 3, even if I can't see it. I've no doubt this has added to my anaemia.

I take 20 mg Hydrocortisone, and sometime DHEA. My last adrenal stress test my DHEA was also low. I get really bad acne, then I'll stop the DHEA for a while. I tried all the supplements root, but it didn't work in 2 years. I was having horrible symptoms like fainting in the shower, I knew I couldn't go on like that. I lost all my pubic hair and armpit hair too, so I knew my adrenals were really bad. Now I have a little hair coming back, and even my nails are growing again.

Yes as you get older you really don't give a damn, I love that. I used to try and be superwoman in my past. I had to let go of my high standards!


Helcaster-I don't have problems with my calf muscles. I do have soreness in my tendons. I try to stretch and keep as limber as possible, but I'm not always consistent about this. I keep meaning to go back to yoga, and someday (soon) I will.

I think that I have been lucky with my Hashimoto's, even though my health history shows that I probably started exhibiting symptoms of this in my 20s (tested high in prolactin when I was 28 and trying to get pregnant). Going gluten free has made a huge difference--I actually was gluten free for about 3 years before my diagnosis, and only because gluten was causing narcolepsy. Since I have never been able to give up running, I've managed to stay reasonably fit through all of this, and ran two marathons. My weight has stayed basically the same since my 20s, although about 15-20 pounds heavier than I was in college.


I ended up in hospital with these issue described here! Just on Wednesday as well. Though I had fractured my middle toe, the pain was shocking!

Posted on here earlier about this. I suspected it was to do with my condition....


I can't locate your Wednesday post. Please link.


Hi, my post failed for some reason :( tried looking for it but it's not there.

Anyways... I've never had these conditions before and as someone who likes to keep active this is very frustrating.

I moved off T4 a few months ago and now I take NDT. Felt great for a week on 2.5 grains but the symptoms soon return. Now moved up to 3 but not much is happening yet. Now my both feet hurt, although this has been coming for a while I suspect.


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